Heterogeneity of acute lymphoblastic leukemia in HIV-seropositive patients

• Published in: Annals of oncology 1994-05, Vol.5 (5), p.437-440
• Main Authors: Gérinière, L., Bastion, Y., Dumontet, C., Salles, G., Espinouse, D., Coiffier, B.
• Format: Article
• Language: English
• Subjects: acute lymphoblastic leukemia; Adult; AIDS/HIV; Antigens, CD - analysis; Antigens, CD7; Antigens, Differentiation, T-Lymphocyte - analysis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; HIV infection; HIV Seropositivity - complications; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Leukemia-Lymphoma, Adult T-Cell - complications; Leukemia-Lymphoma, Adult T-Cell - immunology; Male; Medical sciences; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Prognosis
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/oxfordjournals.annonc.a058876

Background: As opposed to large-cell or Burkitt's-type non-Hodgkin's lymphoma, acute lymphoblastic leukemia (ALL) is rarely observed in HIV-seropositive patients and is not a criteria of AIDS in the 1986 classification established by the C.D.C. Furthermore, the few cases of ALL reported so far were B-cell ALL, Burkitt's-type. Design: We recently observed, with unexpected frequency, ATT, cases in this setting: over a 5-year period, 5 of 25 HIV-positive patients referred to our center for hematological malignancies, had ALL. Three patients, who had previously been asymptomatic with regard to HTV infection, had typical Burkitt's-type ALL. Complete remission was achieved in all cases with high-dose lymphoma-type chemotherapy regimens, but 2 patients relapsed 3 and 27 months after diagnosis. Their clinical characteristics and outcome are discussed with reference to the cases reported thus far in the literature. One patient had common early pre-B ALL with the Philadelphia chromosome, and one had a T-cell ALL with an unusual CD7+, CD4−, CD8− phenotype. Prognosis was very poor in both cases. Conclusion: The exact incidence and the therapeutic management of B-cell ALL in HIV-positive patients warrants further evaluation. In addition, we show that there may be a heterogeneity among ALL cases in this setting, with the first description of 2 non-Burkitt's ALL with atypical features in HIV-positive patients.